Abuse and Neglect of Elderly in Families S. SRINIVAS AND B. VIJAYALAKSHMI ...
Abuse and Neglect of Elderly in Families
Data were gathered from a quota sample of 140 elderly subjected to abuse and/or
neglect by their family members. The respondents included both men and women
living in Visakhapatnam city. The patterns of abuse of the elderly were measured
using a modified form of the Conflict Tactics Scale (Straus, 1979). The results in-
dicate that the most likely victims of elder abuse are widowed women, elderly
with poor economic back ground, and dependent. As regards the forms of abuse,
verbal abuse of the elderly was reported more frequently followed by material
abuse and neglect. A sizeable portion of the respondents have reported physical
abuse. It was also found that abuse has negative implications—social, psycholog-
ical and behavioural for the elderly. Further, the data indicated that the son, the
daughter-in-law and the spouse in that order are the frequently reported abusers.
It is recommended that programmes should be designed to provide adequate op-
portunities for participation of the elderly, to reduce social isolation and to pro-
vide support services to families caring for the elderly to help reduce stress of the
Mr. S. Srinivas is Research Scholar and Dr. B. Vijayalakshmi is Professor,
Department of Social Work, Andhra University, Visakhapatnam.

With the increase in longevity of human life, people are living into ad-
vanced old age. This has created a burden on the families as middle
aged children are now expected to take care of the old people for lon-
ger periods. The resultant burden causes stress leading, in most cases,
to abuse of the elderly. The consequences of elder abuse could be seri-
ous and diverse. According to Star (1987), besides physical injuries,
elder abuse may result in psychological problems for the elderly such
as depression, fear, helplessness, low self-esteem and problems relat-
ing to eating and sleeping.
In the Indian society the situation of the elderly is thought to be less
severe considering the value system, culture and the still sustaining
joint family system. However, the fast changing Indian social

Abuse and Neglect of Elderly in Families 465
scenario leading to the degeneration of the joint family system, dislo-
cation of cultural and familial bonds and loss of respect for the aged
indicate that the family can no longer be a secure place for the elderly.
A few Indian studies have also given strong indication as to the exis-
tence of maltreatment of the elderly in the family context (Rao, 1995;
Usharani, 1989; Vijayakumar, 1991; Vlassoff and Vlassoff, 1980).
Under these circumstances, the problem of elder abuse is most likely
to figure as a priority area requiring attention of the scholars, policy
makers and public in general.
Review of Studies
Interest in elder abuse evolved from studies on other forms of family vi-
olence, especially child abuse and wife abuse during the 1970s in the
West. Ever since the problem was formally recognised, there has been a
growing interest among practitioners and researchers in studying it.
The extant research, including studies of institutional populations and a
few community population surveys (Ogg and Bennett, 1992; Pillemer
and Finkelhor, 1988) taken up in the West, have uncovered cases of
maltreatment of the elderly by the family members. Further, these stud-
ies provide a preliminary picture of the phenomenon — scope of the
problem, the incidence, factors leading to abuse and so on — thereby
providing scope for future research and research-based practice.
Though there is lack of consensus on what constitutes elder abuse,
most of the researchers stipulate that an act must be intentional and
should result in the infliction of physical pain or injury for it to be con-
sidered abusive (Block and Sinnott, 1979; Gelles, 1987; Pillemer and
Finkelhor, 1988). Further, abuse against the elderly may involve acts
of omission such as improper personal or nutritional care that more
actually fall in the category of neglect, both passive and active; psy-
chological abuse; and financial exploitation. Thus, the various dimen-
sions of elder abuse are: physical abuse, verbal assault, physical
neglect, neglect of environment, violation of rights, sexual abuse and
material abuse, meaning that elder abuse may involve any act of omis-
sion or an act that can endanger the life of an elderly person. Studies
have consistently indicated that the most likely victim of elder abuse
is a female of very advanced age, widowed, roleless, functionally im-
paired and living at home with someone (Block and Sinnott, 1979;
Lau and Kosberg, 1979; Steur and Austin, 1980). The dependency of
elderly individuals as a major cause of abuse is widely held in the lit-
erature developed from the gerentological research on families caring

466 S. Srinivas and B. Vijaya Lakshmi
for the elderly. The dependency of the elderly, with physical or mental
impairments, on the caregivers in performing daily activities of living
may result in stress to the caregiver, in turn leading to abuse of the el-
derly unless sufficient resources are available (Block and Sinnott,
1979; Rathborne-McCuan, 1980). Contrary to these observations, fi-
nancial dependency of the caretaker on the elderly was also found to
be a significant factor in elder abuse.
Studies have shown that the abusers are most likely to be middle
aged and usually the offspring (daughter) of the abused (Gelles,
1987). Low economic status, possessing less than high school educa-
tion and holding blue collar jobs are the other reported characteristics
of the abusers. Although much of the literature on elder abuse has fo-
cused on the abuse of elderly parents by adult children, it has been
found that a significant proportion of elder abuse consists of spouse
abuse (Pillemer and Finkelhor, 1988). Social isolation is found to be
another characteristic of the families of abused elderly and the abused
elderly are more likely to be isolated (Phillips, 1983; Pillemer, 1990).
The problem of elder abuse can seriously undermine the quality of
life of the elderly and may have a profound effect on the moral fibre of
the society. For example, deprivation of needed medicines and medi-
cal care can exacerbate the ageing process and may lead to an early
death. Also, financial exploitation, though not life threatening, de-
prives the victim of an independent income and assets (Devi Prasad,
1996). According to Pillemer (1990), three different outcomes —
physical, psychological and behavioural — might result from being a
victim of elder abuse. Further, depression among victims is particu-
larly problematic as it may prevent them from seeking alternatives to
their current situation (Pillemer and Prescott, 1989).
Purpose of the Study
The problem of elder abuse is going to be more serious in future in
view of the changing demography of the elderly population and the
policy implications it has for the care of the elderly in family and com-
munity. However, till date in India, research on ageing was primarily
confined to socio-demographic profiles, problems of and services to
the aged, interpersonal relationships and so on. As a result, certain ar-
eas such as elder abuse suffered selective in-attention. Therefore,
there is a need for empirical studies on elder abuse in India to provide
information about the problem of abuse and neglect of the elderly to
guide practitioners, policy makers and planners.

Abuse and Neglect of Elderly in Families 467
Keeping these aspects in view, the present investigation was un-
dertaken to explore the patterns of abuse and neglect of the elderly in
families. The specific objectives of the study were to:
• find out the socio-demographic profile of the abused and
neglected elderly;
• study the nature and patterns of abuse and neglect of the elderly
in families;
• identify the factors associated with the abuse and neglect of the
elderly; and
• assess the social and psychological implications of abuse and
neglect of the elderly.
Further, the nature and frequency of different forms of abuse suf-
fered by the victims during the past one year (till the date of interview)
and also since they turned 60 years of age, was explored.
Research Setting
The present study was taken up in Visakhapatnam city, which is pop-
ularly known as 'the city of destiny'. According to the 1991 Census,
the city has a population of 7,52,037 and is considered as one of the
rapidly growing cities in India. Studies have shown the increasing
pressures of urbanisation and industrialisation on the families and on
the relationships within the families existing in the city (for example,
Vijayalakshmi and Devi Prasad, 1999). Cutting across the
socioeconomic strata, instances of wife abuse, uxoricide, dowry
deaths, sons beating up their parents, and other forms of family vio-
lence are often reported in the local newspapers (Rajendra Prasad,
1998; Vikram, 1998).
Operational Definitions
An abused elderly, for the purpose of the study, was defined as a per-
son aged 60 years and above, living in a family context and having a
history of abuse and/or neglect by his/her family members. For the
purpose of the study, four major forms of elder abuse were identified
— verbal abuse, physical abuse, material abuse and neglect. Verbal
abuse was defined as acts of insult, swear words or threats perpetrated
against the elderly person at least two or more times in the preceding
year. Physical abuse was defined as perpetrating at least one act of
physical violence against the respondents, since the respondent had

468 S. Srinivas and B. Vijayalakshmi
turned 60 years of age. Material abuse was seen as theft or misuse of
money or exploitation of the financial resources of the elderly by any
of his or her family members at least once since the respondent had
turned 60 years. Neglect was defined as the deprivation of assistance
that the elderly needed for important activities of daily living. If this
had occurred two or more times in the preceding year, for the respon-
dent, then he or she was placed in the neglect category.
In view of the sensitive nature of the topic chosen for the study, the re-
searcher, after considering different approaches to generate the sam-
ple, adopted the following procedure. He got in touch with
appropriate population groups of the aged by identifying such data
sources as hospitals, geriatric health centres, pensioners' associations,
informal groups of elderly who gather in parks and beaches, and the
neighbourhood committees in the slums. A preliminary survey was
conducted to draw a fairly mixed sample of elderly from different so-
cioeconomic backgrounds with a history of abuse. A sample of 140
elderly (both men and women) was selected for the study. The results
reported in this paper are based on the responses of these 140 elderly
collected during the period from August 1995 to January 1996.
Data Collection Instrument
A detailed interview schedule was used to collect data from the sam-
ple elderly. The schedule covered major aspects such as profiles of the
abused and the abuser; health and physical condition of the elderly
and support from the family members; psychological well-being of
the elderly; issues leading to abuse and neglect of elderly; and details
of material abuse. The schedule also utilised the Conflict Tactics
Scale (CTS) to measure verbal and physical abuse. The CTS consists
of a list of 19 items, which a family member adopts while confronting
a conflict situation with another family member. The items in the
Scale start with those acts which are less coercive (for example, dis-
cussing the issue calmly with others) and gradually moves to more co-
ercive and more aggressive forms of tactics towards the end of the list
(for example, using sharp instrument or knife against the elderly). Ac-
cordingly, the items are grouped under 3 sub-scales — use of rational
discussion, verbal aggression and physical violence. Each item asks if
the mode was employed ever since the respondent had turned 60 years
of age. It also asks for the number of times each action occurred

Abuse and Neglect of Elderly in Families 469
during the past year, which may range from never to 10 or more times.
Frequencies were calculated from these data.
Reliability of the CTS was determined by both split-half and
test-retest methods. Both these were administered to 30 respondents.
The split-half analysis scores of these 30 respondents were taken and
the items of the CTS were divided into two halves on odd-even crite-
ria. A product moment correlation-coefficient of internal reliability of
the Scale was computed using the Spearman-Brown formula1 to cor-
rect for attenuation in the split-half test. Also, a retest was conducted
for the same 30 respondents after 30 days of the conduct of the first
test. The reliability of the Scale (abuse patterns since the elderly
turned 60 years) was r=0.87 for the split-half method and for
test-retest method it was 0.95. As regards the reliability of the Scale in
measuring abusive behaviour during the past one year (till the date of
interview), it was r=0.9 for both the split-half method and for
test-retest method. The reliability co-efficient (yxx) came to 0.93
(abuse patterns since the elderly turned 60 years) and 0.97 (abusive
behaviour during the past one year till the date of interview).
The Abused
Of the total sample, 52.9 per cent were women and 47.1 per cent were
men. The mean age of the sample population came to 66 years with a
majority of the sample respondents falling in the age range of 60-67
years. There was a large percentage of Hindus (86.4) in the study sam-
ple, because Hinduism is the predominant religion in Visakhapatnam.
More than half of the respondents belong to backward classes (53.5
per cent). However, a significant number are from other castes (34.3
per cent) and a few are from scheduled castes (11 per cent). As regards
the marital status, around 85 per cent of the women were widows in
contrast to majority of the men (71.2 per cent), who had a living
spouse. A large number of the respondents had some schooling or col-
legiate education. In fact, about 16.7 per cent of them were graduates
or above. However, as compared to men (16.7 per cent), a majority of
the women were illiterate (75.6 per cent). Similarly, as compared to
men (31.8 per cent), only one woman was a graduate. A sizeable num-
ber of respondents came from high income families, that is, Rs.

470 S. Srinivas and B. Vijayalakshmi
6,000/- and above, though the majority were from low income fami-
lies (56.4 per cent families had an income less than Rs. 2,000/- per
month). Of the dependants with no income, women were more (44.6
per cent) as compared to men (12.1 per cent) (Table 1).
TABLE 1: Background Characteristics of the Sample Elderly by Sex
Age (in years)
6 0 - 6 3
6 4 - 6 7
6 8 - 7 1
7 2 - 7 5
76 and above
Other castes
Backward classes
Scheduled caste
Marital Status
Separated or divorced
PUC/Inter mediate
Graduate and above
Family income (in Rs. per month)
Below 1000
1 0 0 1 - 2 0 0 0
2 0 0 1 - 4 0 0 0
4 0 0 1 - 6 0 0 0
6001 and above
Respondent's income (in Rs. per month)
No income
Below 500
501 - 1000
1 0 0 1 - 2 0 0 0
2001 and above
Note: This category includes the Muslim respondents.

Abuse and Neglect of Elderly in Families 471
The Abuser
The respondents were asked to mention the person most difficult to
get along with in their family and his/her relationship with them.
Both men and women (37.9 per cent and 33.3 per cent respectively),
the son as the most frequent abuser. As against men (13.7 per cent),
more women (36.5 per cent) reported that their daughter-in-law was
the most abusive family member. It was the husband who often re-
ported being abused by the wife (33.3 per cent), whereas the reverse
was reported to be as less as only four per cent. The middle aged per-
son (mean age=37 years) appears to be frequently the abuser. The
abusers included an almost equal number of men and women and a
majority of them were married (81.4 per cent). About 30 per cent
had collegiate education. The abusers were from a variety of occu-
pations, and included housewives and unemployed who comprised
38.6 per cent and 11.4 per cent, respectively. However, almost half
of them (48.6 per cent) did not have an income of their own (See Ta-
ble 2). In fact, some of the abusers were financially very dependent
(19.3 percent) or somewhat dependent (19.3 percent) on the sample
TABLE 2: Socio-Demographic Profile of the Abuser
Age (in years)
Below 20
2 1 - 3 0
3 1 - 4 0
4 1 - 5 0
51 and above
Marital Status
Widow (er)
Had no education
Primary education
Secondary education
Collegiate Education

472 S. Srinivas and B. Vijayalakshmi
Government Service
Business - small
Skilled labour
Unskilled labour
House wife
Income (in Rs. per month)
No income
Below 1000
1 0 0 1 - 2 0 0 0
3 0 0 1 - 4 0 0 0
4001 and above
Note: N = 140
* Others include teachers (2), clerical (8), retired (1) and business (1).
Patterns of Abuse
The study attempted at ascertaining the four major patterns of abuse
that is, physical abuse, verbal abuse, neglect and material abuse. Ver-
bal abuse is the most frequently reported form of abuse followed by
material abuse and neglect. Physical abuse is also reported by a size-
able number of respondents. Table 3 shows the distribution of respon-
dents by the categories of abuse they suffered in their family context.
TABLE 3: Distribution of the Sample Elderly by Patterns of Abuse
Type of Abuse
Verbal abuse
Physical abuse
Material abuse
Note: N=140
Verbal Abuse
A majority of the sample population reported that their abusers had
said some thing to spite them (80 per cent) and insulted or sworn at
them (36.4 per cent) during the past one year. Further, they were
threatened physically (7.2 per cent), which lead to their humiliation.

Abuse and Neglect of Elderly in Families 473
Physical Abuse
Pushing, grabbing or shoving (17 per cent); trying to slap or to hit
(10.7 per cent); and hitting or trying to hit with something (10 per
cent) were the frequently reported patterns of physical abuse. A
few sample population also reported that their abusers beat them
up (6.4 per cent) and locked them in some place (4.2 per cent) (Ta-
ble 4).
TABLE 4: Details of Physical Abuse
Note: N = 140
About 37 per cent of the sample population reported that they were
neglected by their family members. A majority reported that they
were frequently neglected, that is two to six times (49.1 per cent) and
7-10 times (45.5 per cent) during the past one year. In a majority of
cases (65.4 per cent) the neglect was reported to be somewhat serious,
whereas in about 25 per cent of cases it was serious.
Material Abuse
A majority of sample population (52.9 per cent) reported to having
been subjected to material abuse at least once since they turned 60
years of age. A significant number of the elderly reported that their
abusers had tried to convince them to give money (73 per cent);

474 S. Srinivas and B. Vijayalakshmi
persuaded them to let the abuser handle their finances (45 percent); or
sign over ownership of the house (36.5 per cent); and cheated or
tricked them elderly for money (31 per cent).
Factors Associated with Elder Abuse
The association between some of the demographic variables of the
abused and their abuser was tested. Factors such as sex, marital status
and dependency of the abused seem to be having a greater association
with elder abuse.
Both men and women most frequently reported verbal abuse (77.3 per
cent and 83.8 per cent respectively). The data also indicated that more
women were subjected to physical abuse and neglect as against their
male counterparts and more so in terms of physical abuse (33.8 per
cent of women as against 10.6 per cent of men). However, material
abuse was more against men (61.2 per cent) than women (39.2 per
cent). This could be because more men had an income of their own
and had assets.
TABLE 5: Distribution of Respondents by Sex and Types of Abuse Suffered
Type of Abuse
Verbal abuse
Physical abuse
Material abuse
Marital Status
Table 6 shows that the widowed are more frequently subjected to all
forms of abuse, particularly to physical abuse and neglect (30.4 per
cent and 43.9 respectively) compared to the respondents whose
spouse is alive (10.9 per cent and 29.1 per cent respectively). It was
also observed that more widows are subjected to verbal abuse and to
material abuse (84.1 per cent and 41.3 per cent respectively) than the
women whose husbands were alive (74.5 per cent and 37.5 per cent).
Further, the widowers were more frequently physically abused (21
per cent) than the married men (6.4 per cent).

Abuse and Neglect of Elderly in Families 475
TABLE 6: Details of Abuse by Marital Status and Sex
It is found that those elderly who were dependent on their family
members for performing their activities related to daily living were at
the risk of abuse and neglect. This was more so in the case of women.
The data also showed that even among the elderly who were capable
of attending to their personal chores, women were more at risk of ver-
bal abuse (80 per cent) and material abuse (40 per cent). As regards
neglect of the elderly, more dependent women (57.4 per cent) were
found to be at risk as compared to dependent men (33.3 per cent).
Both men and women who were independent in their daily activities
were free from any neglect (Table 7).
TABLE 7: Dependency of Elderly in their Activities of Daily Living by Types of
Note: N=140
Implications of Abuse and Neglect for the Elderly
When asked how happy they were, a large number of the sample el-
derly reported that they were not happy at all (40.7 per cent) or a little
unhappy (45 per cent). More women (55.4 per cent) reported to be not
happy at all in contrast to men (24.3 per cent). A significant number of
the sample elderly (45.7 per cent) expressed that they had no one to

476 S. Srinivas and B. Vijayalakshmi
trust or believe in, though they were living with their families at the
time of the study. A majority of the sample population, of both men
and women (30.3 per cent and 62.1 per cent respectively), were found
to be often lacking in enthusiasm and reported poor appetite (47 per
cent and 64.8 per cent) and disturbed sleeping patterns (59.1 per cent
and 85.2 per cent). Further, they felt confused, powerless and helpless
and became increasingly dependent on others. A sizeable number of
the sample population (28.6 per cent) reported to have considered
ending their lives. These suicidal intentions/ideas were reported by
both men (19.7 per cent) and women (36.5 per cent), thereby indicat-
ing that the psychological well-being of women was worse than that
of men.
The conclusions drawn from the findings are confined to the study
sample as the data were gathered from a purposive sample with the re-
lated characteristics. However, some general observations, when sup-
ported by findings of extant research, were made within the
limitations mentioned above. The findings of the study indicated that
the widowed and women living with their children have been abused
in more the families. Similar observations were made in the studies
taken up in the United States, Canada and other Western countries,
where the typical victim of elder abuse was depicted as widowed,
roleless and functionally impaired and usually living with someone
(Block and Sinnott, 1979; Lau and Kosberg, 1978; Pedric-Cornell and
Gelles, 1982). The results of the present study indicate that age of the
respondent and economic circumstances in the family have no bear-
ing on the risk of being abused. As regards educational background,
though a large number of the respondents are illiterates, there are a
few who are graduates or have higher qualifications.
The son, the daughter-in-law and the spouse, in that order, were
frequently reported to be the abusers. In the Indian context, tradition-
ally, the elderly would prefer to live with the married son. In most
cases women, particularly the daughters-in-law, take care of the de-
pendants, including the elderly in their family. This might be the rea-
son for the son and daughter-in-law being frequently reported as
abusers. In the case of spouses being reported as abusers, more
women were reported to be subjecting their husbands to abuse and ne-
glect with the reverse being observed less frequently. This could be
because, usually, husbands are older than their wives and tend to

Abuse and Neglect of Elderly in Families 411
become dependent on the relatively younger wife for their daily activ-
ities of living. Moreover, the wife burdened by the dependent husband
at her advanced age may become abusive. This finding strengthens
the argument that elder abuse is much more by the spouse than by the
child (Pillemer and Finkelhor, 1998). Financial dependency of the
abuser on the victim is also found to be associated with risk of the
latter being abused, as abusers were reportedly somewhat (19.3 per
cent) to very dependent (19.3 per cent), financially, on the victims.
Pillemer (1985) has also made similar observations.
Verbal abuse was the most frequently reported form of abuse, fol-
lowed by material abuse. Shouting at the elderly and insulting them
were often observed. The elderly were physically abused by way of
pushing, grabbing, shoving, and so on. A few of them were also being
hit with something, beaten up and locked in some place. However, not
many were subjected to such forms of severe physical abuse. It may
be observed from the findings that the elderly were subjected to vari-
ous forms of verbal and physical abuse. Further, neglect was reported
as a form of abuse in a significant number of cases (25 per cent). The
findings revealed that these abusive experiences had negative outco-
mes for the elderly which include lack of enthusiasm, disturbed eating
and sleep problems, feeling of powerlessness and of isolation. Ne-
glect and material abuse of the elderly though not life threatening may
deprive the elderly from fulfilling their basic needs such as food, med-
icines, and so on, and also create feelings of insecurity. The feeling of
being unwanted and having no one to trust in the family appears to be
resulting in suicidal ideas in a sizeable number of the sample popula-
Though the problem of elder abuse has come to light only in the re-
cent past in the Indian context, with the changing demographics, the
situation of the elderly, particularly in the family context, is expected
to further exacerbate. Therefore, there is an urgent need to formulate
strategies which would ensure a better quality of life to the elderly.
Provision of services such as adult day care, domestic assistance, mo-
bile geriatric health services, and home nursing care would reduce the
stress of the caregiver and the resultant abuse of the elderly.
Programmes are to be so designed that they have scope for participa-
tion of the elderly to reduce their social isolation. Creating awareness
among the elderly regarding the steps they can take to address the in-
stances of maltreatment in the family context could be very useful in
view of the existing 'no reporting and under reporting' of elder abuse

478 S. Srinivas and B. Vijayalakshmi
cases. In the absence of reliable data about incidence and different
forms of elder abuse, there is a need for research using large and rep-
resentative samples, which has scope for arriving at estimates of inci-
dence and prevalence rates of abuse and provide deeper insights into
the problem of elder abuse.
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THE INDIAN JOURNAL OF SOCIAL WORK, volume 62, issue 3, July 2001